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Archive for the ‘Population Health Management, Genetics & Pharmaceutical’ Category


Recombinant Coronavirus Vaccines Delivered via Microneedle Array

Curator: Irina Robu, PhD

Coronavirus is an evolving pathogen with exponentially increasing significance due to the high case fatality rate, the large distribution of reservoir, and the lack of medical countermeasures. The public health emergencies triggered by coronaviruses, including SARS-CoV and SARS-CoV-2, obviously validate the urgency to assess candidate vaccines to fight these outbreaks. Continuous research contributes to the efforts of scientists to quickly progress safe vaccines against these developing infections. The recent COVID-19 pandemic indicates a vital need for the rapid design, production, testing, and clinical translation of candidate vaccines.

Coronavirus virus particles contain four main structural proteins. These are the spike, membrane, envelope, and nucleocapsid proteins, all of which are encoded within the 3′ end of the viral genome. Coronaviruses contain a non-segmented, positive-sense RNA genome, which contains a 5′ cap structure along with a 3′ poly (A) tail, allowing it to act as a mRNA for translation of the replicase polyproteins. The replicase gene encoding the nonstructural proteins inhabits two-thirds of the genome, which make up only about 10 kb of the viral genome. The 5′ end of the genome contains a leader sequence and untranslated region that encompasses multiple stem loop structures required for RNA replication and transcription. Furthermore, at the start of each structural gene are the transcriptional regulatory sequences that are essential for expression of each of these genes.

Researchers at U of Pittsburg generated codon optimized MERS-S1 subunit vaccines fused with a foldon trimerization domain to mimic the native viral structure. They engineered immune stimulants (RS09 or flagellin, as TLR4 or TLR5 agonists) into this trimeric design and tested the pre-clinical immunogenicity of MERS-CoV vaccines in mice, distributed subcutaneously by needle injection or intracutaneously by dissolving microneedle arrays by assessing virus specific IgG antibodies in the serum of vaccinated mice by ELISA and using virus neutralization assays.

Microneedle array mediated immunization has several mechanistic differences from traditional intramuscular needle injections, which could clarify the variations in the magnitude and kinetics of the ensuing responses. Due to the urgent need for COVID-19 vaccines, they used this approach to quickly advance MNA SARS-CoV-2 subunit vaccines and tested their pre-clinical immunogenicity in-vivo by manipulating the previous research on MNA MERS-CoV vaccines.

Even though it is still premature to predict whether humans immunized with these vaccine candidates will have similar responses and be protected from SARS-CoV-2 infections, their previous research show that development, production, and initial animal testing of clinically translatable MNA vaccine candidates against SARS-CoV-2. Incidentally it will be vital to determine whether antibodies from MNA-SARS-CoV-2 immunized animals will neutralize virus infectivity.

Finally, we note that the immunogenicity differences between MNA coronavirus vaccines and coronavirus vaccines delivered by traditional needle injection that we observe will need to be evaluated in clinical trials to establish the clinical advantages of MNA delivery.

SOURCE

E. Kim et al., Microneedle array delivered recombinant coronavirus vaccines: Immunogenicity and rapid translational development, EBioMedicine (2020).

Fehr, Anthony R, and Stanley Perlman. Coronaviruses: an overview of their replication and pathogenesis. Methods in molecular biology, vol. 1282 (2015): 1-23.

Susan R. Weiss, Sonia Navas-Martin. Coronavirus Pathogenesis and the Emerging Pathogen Severe Acute Respiratory Syndrome Coronavirus. Microbiology and Molecular Biology Reviews Dec 2005, 69 (4) 635-664.

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Live Notes and Conference Coverage in Real Time. COVID19 And The Impact on Cancer Patients Town Hall with Leading Oncologists; April 4, 2020

Reporter: Stephen J. Williams, PhD 

@StephenJWillia2

UPDATED 4/08/2020 see below

The Second in a Series of Virtual Town Halls with Leading Oncologist on Cancer Patient Care during COVID-19 Pandemic: What you need to know

The second virtual Town Hall with Leading International Oncologist, discussing the impact that the worldwide COVID-19 outbreak has on cancer care and patient care issues will be held this Saturday April 4, 2020.  This Town Hall Series is led by Dr. Roy Herbst and Dr. Hossain Borghaei who will present a panel of experts to discuss issues pertaining to oncology practice as well as addressing physicians and patients concerns surrounding the risk COVID-19 presents to cancer care.  Some speakers on the panel represent oncologist from France and Italy, and will give their views of the situation in these countries.

 

Speakers include:

Roy S. Herbst, MD, PhD, Ensign Professor of Medicine (Medical Oncology) and Professor of Pharmacology; Chief of Medical Oncology, Yale Cancer Center and Smilow Cancer Hospital; Associate Cancer Center Director for Translational Research, Yale Cancer Center

Hossain Borghaei, DO, MS , Chief of Thoracic Medical Oncology and Director of Lung Cancer Risk Assessment, Fox Chase Cancer Center

Giuseppe Curigliano, MD, PhD, University of Milan and Head of Phase I Division at IEO, European Institute of Oncology

Paolo Ascierto, MD National Tumor Institute Fondazione G. Pascale, Medical oncologist from National Cancer Institute of Naples, Italy

Fabrice Barlesi, MD, PhD, Thoracic oncologist Cofounder Marseille Immunopole Coordinator #ThePioneeRproject, Institut Gustave Roussy

Jack West, MD, Department of Medical Oncology & Therapeutics Research, City of Hope California

Rohit Kumar, MD Department of Medicine, Section of Pulmonary Medicine, Fox Chase Cancer Center

Christopher Manley, MD Director, Interventional Pulmonology Fox Chase Cancer Center

Hope Rugo, MD FASCO Division of Hematology and Oncology, University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center

Harriet Kluger, MD Professor of Medicine (Medical Oncology); Director, Yale SPORE in Skin Cancer, Yale Cancer Center

Marianne J. Davies, DNP, MSN, RN, APRN, CNS-BC, ACNP-BC, AOCNP Assistant Professor of Nursing, Yale University

Barbara Burtness, MD Professor of Medicine (Medical Oncology);  Head and Neck Cancers Program, Yale University

 

@pharma_BI and @StephenJWillia2 will be Tweeting out live notes using #CancerCareandCOVID19

Live Notes

Part I: Practice Management

Dr. Jack West from City of Hope talked about telemedicine:  Coordination of the patient experience, which used to be face to face now moved to a telemedicine alternative.  For example a patient doing well on personalized therapy, many patients are well suited for a telemedicine experience.  A benefit for both patient and physician.

Dr. Rohit Kumar: In small cancer hospitals, can be a bit difficult to determine which patient needs to come in and which do not.  For outpatients testing for COVID is becoming very pertinent as these tests need to come back faster than it is currently.  For inpatients the issue is personal protection equipment.  They are starting to reuse masks after sterilization with dry heat.   Best to restructure the system of seeing patients and scheduling procedures.

Dr. Christopher Manley: hypoxia was an issue for COVID19 patients but seeing GI symptoms in 5% of patients.  Nebulizers have potential to aerosolize.  For patients in surgery prep room surgical masks are fine.  Ventilating these patients are a challenge as hypoxia a problem.  Myocarditis is a problem in some patients.  Diffuse encephalopathy and kidney problems are being seen. So Interleukin 6 (IL6) inhibitors are being used to reduce the cytokine storm presented in patients suffering from COVID19.

Dr. Hope Rugo from UCSF: Breast cancer treatment during this pandemic has been challenging, even though they don’t use too much immuno-suppressive drugs.  How we decide on timing of therapy and future visits is crucial.  For early stage breast cancer, neoadjuvant therapy is being used to delay surgeries.  Endocrine therapy is more often being used. In patients that need chemotherapy, they are using growth factor therapy according to current guidelines.  Although that growth factor therapy might antagonize some lung problems, there is less need for multiple visits.

For metastatic breast cancer,  high risk ER positive are receiving endocrine therapy and using telemedicine for followups.  For chemotherapy they are trying to reduce the schedules or frequency it is given. Clinical trials have been put on hold, mostly pharmokinetic studies are hard to carry out unless patients can come in, so as they are limiting patient visits they are putting these type of clinical studies on hold.

Dr. Harriet Kluger:  Melanoma community of oncologists gathered together two weeks ago to discuss guidelines and best practices during this pandemic.   The discussed that there is a lack of data on immunotherapy long term benefit and don’t know the effectiveness of neoadjuvant therapy.  She noted that many patients on BRAF inhibitors like Taflinar (dabrafenib)   or Zelboraf (vemurafenib) might get fevers as a side effect from these inhibitors and telling them to just monitor themselves and get tested if they want. Yale has also instituted a practice that, if a patient tests positive for COVID19, Yale wants 24 hours between the next patient visit to limit spread and decontaminate.

Marianne Davies:  Blood work is now being done at satellite sites to limit number of in person visits to Yale.  Usually they did biopsies to determine resistance to therapy but now relying on liquid biopsies (if insurance isn’t covering it they are working with patient to assist).  For mesothelioma they are dropping chemotherapy that is very immunosuppressive and going with maintenance pembrolizumab (Keytruda).  It is challenging in that COPD mimics the symptoms of COVID and patients are finding it difficult to get nebulizers at the pharmacy because of shortages; these patients that develop COPD are also worried they will not get the respirators they need because of rationing.

Dr. Barbara Burtness: Head and neck cancer.  Dr. Burtness stresses to patients that the survival rate now for HPV positive head and neck is much better and leaves patients with extra information on their individual cancers.  She also noted a registry or database that is being formed to track data on COVID in patients undergoing surgery  and can be found here at https://globalsurg.org/covidsurg/

About CovidSurg

  • There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery.
  • Capturing real-world data and sharing international experience will inform the management of this complex group of patients who undergo surgery throughout the COVID-19 pandemic, improving their clinical care.
  • CovidSurg has been designed by an international collaborating group of surgeons and anesthetists, with representation from Canada, China, Germany, Hong Kong, Italy, Korea, Singapore, Spain, United Kingdom, and the United States.

Dr. Burtness had noted that healthcare care workers are at high risk of COVID exposure during ear nose and throat (ENT) procedures as the coronavirus resides in the upper respiratory tract.  As for therapy for head and neck cancers, they are staying away from high dose cisplatin because of the nephrotoxicity seen with high dose cisplatin.  An alternative is carboplatin which generally you do not see nephrotoxicity as an adverse event (a weekly carboplatin).  Changing or increasing dose schedule (like 6 weeks Keytruda) helps reduce immunologic problems related to immunosupression and patients do not have to come in as often.

Italy and France

Dr. Paolo Ascierto:   with braf inhibitors, using in tablet form so patients can take from home.  Also they are moving chemo schedules for inpatients so longer dosing schedules.  Fever still a side effect from braf inhibitors and they require a swab to be performed to ascertain patient is COVID19 negative.  Also seeing pneumonitis as this is an adverse event from checkpoint inhibitors so looking at CT scans and nasal swab to determine if just side effect of I/O drugs or a COVID19 case.  He mentioned that their area is now doing okay with resources.

Dr. Guiseppe Curigliano mentioned about the redesign of the Italian health system with spokes and hubs of health care.  Spokes are generalized medicine while the hubs represent more specialized centers like CV hubs or cancer hubs.  So for instance, if a melanoma patient in a spoke area with COVID cases they will be referred to a hub.  He says they are doing better in his area

In the question and answer period, Dr. West mentioned that they are relaxing many HIPAA regulations concerning telemedicine.  There is a website on the Centers for Connective Health Policy that shows state by state policy on conducting telemedicine.   On immuno oncology therapy, many in the panel had many questions concerning the long term risk to COVID associated with this type of therapy.  Fabrice mentioned they try to postpone use of I/O and although Dr. Kluger said there was an idea floating around that PD1/PDL1 inhibitors could be used as a prophylactic agent more data was needed.

Please revisit this page as the recording of this Town Hall will be made available next week.

UPDATED 4/08/2020

Below find the LIVE RECORDING and TAKEAWAYS by the speakers

 

 
Town Hall Takeaways
 

Utilize Telehealth to Its Fullest Benefit

 

·       Patients doing well on targeted therapy or routine surveillance are well suited to telemedicine

·       Most patients are amenable to this, as it is more convenient for them and minimizes their exposure

·       A patient can speak to multiple specialists with an ease that was not previously possible

·       CMS has relaxed some rules to accommodate telehealth, though private insurers have not moved as quickly, and the Center for Connected Health Policy maintains a repository of current state-by-state regulations:  https://www.cchpca.org/

 

Practice Management Strategies

 

·       In the face of PPE shortages, N95 masks can be decontaminated using UV light, hydrogen peroxide, or autoclaving with dry heat; the masks can be returned to the original user until the masks are no longer suitable for use

·       For blood work or scans, the use of external satellite facilities should be explored

·       Keep pumps outside of the room so nurses can attend to them quickly

·       Limit the use of nebulizers, CPAPs, and BiPAPs due to risk of aerosolization

 

Pool Our Knowledge for Care of COVID Patients

 

·       There is now a global registry for tracking surgeries in COVID-positive cancer patients:  https://globalsurg.org/cancercovidsurg/

·       Caution is urged in the presence of cardiac complications, as ventilated patients may appear to improve, only to suffer severe myocarditis and cardiac arrest following extubation

·       When the decision is made to intubate, intubate quickly, as less invasive methods result in aerosolization and increased risks to staff

 

Study the Lessons of Europe

 

·       The health care system in Italy has been reorganized into “spokes” and “hubs,” with a number of cancer hubs; if there is a cancer patient in a spoke hospital with many COVID patients, this patient may be referred to a hub hospital

·       Postpone adjuvant treatments whenever possible

·       Oral therapies, which can be managed at home, are preferred over therapies that must be administered in a healthcare setting

·       Pneumonitis patients without fevers may be treated with steroids, but nasal swab testing is needed in the presence of concomitant fever

·       Any staff who are not needed on site should be working from home, and rotating schedules can be used to keep people healthy

·       Devise an annual epidemic control plan now that we have new lessons from COVID

 

We Must Be Advocates for Our Cancer Patients

 

·       Be proactive with other healthcare providers on behalf of patients with a good prognosis

·       Consider writing letters for cancer patients for inclusion into their chart, or addendums on notes, then encourage patients to print these out, or give it to them during their visit

·       The potential exists for a patient to be physiologically stable on a ventilator, but intolerant of decannulation; early discussions are necessary to determine reasonable expectations of care

·       Be sure to anticipate a second wave of patients, comprised of cancer patients for whom treatments and surgery have been delayed!

 

Tumor-Specific Learnings

 

Ø  Strategies in Breast Cancer:

·       In patients with early-stage disease, promote the use of neoadjuvant therapy where possible to delay the need for surgery

·       For patients with metastatic disease in the palliative setting, transition to less frequent chemotherapy dosing if possible

·       While growth factors may pose a risk in interstitial lung disease, new guidelines are emerging

 

Ø  Strategies in Melanoma:

·       The melanoma community has released specific recommendations for treatment during the pandemic:  https://www.nccn.org/covid-19/pdf/Melanoma.pdf

·       The use of BRAF/MEK inhibitors can cause fevers that are drug-related, and access to an alternate clinic where patients can be assessed is a useful resource

 

Ø  Strategies in Lung Cancer:

·       For patients who are stable on an oral, targeted therapy, telehealth check-in is a good option

·       For patients who progress on targeted therapies, increased use of liquid biopsies when appropriate can minimize use of bronchoscopy suites and other resources

·       For patients on pembrolizumab monotherapy, consider switching to a six-week dosing of 400 mg

·       Many lung cancer patients worry about “discrimination” should they develop a COVID infection; it is important to support patients and help manage expectations and concerns

 

 

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The Second in a Series of Virtual Town Halls with Leading Oncologist on Cancer Patient Care during COVID-19 Pandemic: What you need to know

Reporter: Stephen J. Williams, PhD 

@StephenJWillia2

The second virtual Town Hall with Leading International Oncologist, discussing the impact that the worldwide COVID-19 outbreak has on cancer care and patient care issues will be held this Saturday April 4, 2020.  This Town Hall Series is led by Dr. Roy Herbst and Dr. Hossein Borghaei who will present a panel of experts to discuss issues pertaining to oncology practice as well as addressing physicians and patients concerns surrounding the risk COVID-19 presents to cancer care.  Some speakers on the panel represent oncologist from France and Italy, and will give their views of the situation in these countries.

Please register at the link below.

Link to register: https://us04web.zoom.us/webinar/register/WN_YzsFbGacTg2DV73j6pYqxQ

This series is being hosted in partnership with Axiom Healthcare Strategies, Inc..

The Town Hall proceedings and live notes will be made available on this site and Live Notes will be Tweeted in Real Time using the #CancerCareandCOVID19 and @pharma_BI

 

Webinar banner

   Microsoft (Outlook)
Topic

COVID-19 Oncology Town Hall
Description

The goal of these town halls is to improve outcomes of cancer patients across the globe, by sharing insights and lessons learned from oncologists fighting COVID-19. Dr. Roy Herbst and Dr. Hossein Borghaei will be joined by a panel of thought leaders with expertise in a variety of solid tumors to discuss how COVID-19 has impacted patient care in oncology.

Following the session, a video, transcript, and key takeaways will be released on Monday 4/6.

Time

For Live Notes From the Last Town Hall Meeting Specifically on Lung Cancer and COVID19 please go to

For more information on Cancer Care and Issues of Cancer and COVID19 please see our Coronavirus Portal at

https://pharmaceuticalintelligence.com/coronavirus-portal/

 

 

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Tweets and Retweets @ COVID-19 and AI: A Virtual Conference – Human-Centered Artificial Intelligence Institute, Stanford University, 4/1/2020, 9AM PST – 3:30PM PST @StanfordHAI  BY @pharma_BI and @AVIVA1950

COVID-19 and AI: A Virtual Conference – Human-Centered Artificial Intelligence Institute, Stanford University, 4/1/2020, 9AM PST – 3:30PM PST @StanfordHAI @pharma_BI @AVIVA1950

Real Time coverage: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2020/04/01/covid-19-and-ai-a-virtual-conference-human-centered-artificial-intelligence-stanford-university-4-1-2020-9am-pst-330pm-pst/

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Vaccines are one of the most powerful tools to curb a pandemic and prevent its recurrence,

says. He discusses how AI tools built upon immunology knowledge and data can increase the chances of finding an effective vaccine. stanford.io/3aBidgh

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Aviva Lev-Ari
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pharmaceuticalintelligence.com/coronavirus-po Stanford Institute for Human-Centered Artificial Intelligence (HAI) Conference on COVID-19 and AI: A Virtual Conference on April 1, 2020 beginning at 9:00am (PDT). event covered in real time

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Curation of Resources for High Risk People  to COVID-19 Infection :Guidances for Transplant Patients

Curator: Stephen J. Williams, PhD

 

From the American Society of Transplantation

Source: https://www.myast.org/information-transplant-professionals-and-community-members-regarding-2019-novel-coronavirus

INFORMATION FOR TRANSPLANT PROFESSIONALS AND COMMUNITY MEMBERS REGARDING 2019 NOVEL CORONAVIRUS

The recent outbreak of a novel coronavirus (COVID-19) in Wuhan, Hubei Province, China and the finding of infection in many other countries including the United States has led to questions among transplant programs, Organ Procurement Organizations (OPOs) and patients. The Organ Procurement and Transplantation Network (OPTN) strives to provide up-to-date information to answer these questions and to provide guidance as needed. Accordingly, the OPTN Ad Hoc Donor Transmission Advisory Committee (DTAC), American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS), after careful review of information available from the Centers for Disease Control and Prevention (CDC), offers information to transplant programs and OPOs in light of these concerns. Please visit the OPTN  website for more information.

The American Society of Transplantation recently conducted a Town Hall on guidances for transplant patients with regard to the COVID-19 pandemic.  A video recording of the Town Hall is given below

 

 

Description of the Town Hall by the AST: A number of transplant organizations from around the world have partnered to develop this educational webinar for the organ donation and transplantation communities. Our goal is to share experiences to date and respond to your questions about the impact of COVID-19 on organ donation and transplantation.

 

This webinar was recorded on March 23, 2020.

 

Resource Handout: https://www.myast.org/sites/default/f…

AST COVID-19 Page: https://www.myast.org/covid-19-inform…

 

The American Society of Transplantation has other up to date resources on their webpage at https://www.myast.org/covid-19-information#

AST Resources For Transplant Professionals 

Information for Transplant Professionals (Updated 3/31/20)

Medication Access and Drug Shortage Concerns During the COVID-19 Pandemic: Frequently Asked Questions (posted 3/31/20)

AST Resources For Transplant Recipients and Candidates 

Information for Transplant Recipients and Candidates (Updated 3/30/20)

Other Resources like videos and further articles

Frequently Asked Questions can be found here https://www.myast.org/coronavirus-disease-2019-covid-19-frequently-asked-questions-transplant-candidates-and-recipients

Mark Spigler from the American Kidney Fund listed some tips specifically for kidney transplant recipients. In his blog

Coronavirus, COVID-19 and kidney patients: what you need to know he wrote:

Because transplant recipients take immunosuppressive drugs, they are at higher risk of infection from viruses such as cold or flu. To limit the possibility of being exposed to the coronavirus that causes COVID-19, transplant patients should follow the CDC’s tips to avoid catching or spreading germs, and contact their health care provider if they develop cold or flu-like symptoms. By being informed and taking your own personal precautions, you can help reduce your risk of coming in contact with the coronavirus that causes COVID-19. You can find more information and resources for kidney patients by visiting our special coronavirus webpage at KidneyFund.org/coronavirus. We’ll update the page with important information for kidney patients and their caregivers as the coronavirus crisis continues to unfold.

Resources from the National Kidney Foundation

Source: https://www.kidney.org/coronavirus/transplant-coronavirus

Coronavirus and Kidney Transplants (please click on the links below)

For more information concerning various issues on COVID-19 please see our Coronavirus Portal at:

https://pharmaceuticalintelligence.com/coronavirus-portal/

 

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Stanford Institute for Human-Centered Artificial Intelligence (HAI) Conference on COVID-19 and AI: A Virtual Conference on April 1, 2020 beginning at 9:00am (PDT).

COVID-19 and AI: A Virtual Conference – Human-Centered Artificial Intelligence Institute, Stanford University, 4/1/2020, 9AM PST – 3:30PM PST

https://hai.stanford.edu/events/covid-19-and-ai-virtual-conference/agenda?mkt_tok=eyJpIjoiWVRobFpXTmhZV0ZsWVdFeiIsInQiOiJvejBtSFwvV044bEtBeUJuMlEzSEJOdDJ5K2NFMVwvMFwvemZxb1N6cEc5RU9NOTZCMGt0eEJTYzNtbWhWend4eTFhRnl5a2dSbm44T0JoZ3hOOTNMTk54eUU1UzFwNTBcLzhTT2VRbFwvdThpVzlXQlwvc2k5QWswSVVraGl0VXlSa3ZSRCJ9

@StanfordHAI

@pharma_BI

@AVIVA1950

Real Time coverage: Aviva Lev-Ari, PhD, RN

Agenda

Wednesday, April 1, 2020

*Speakers and session titles are subject to change

*All times are in PDT

Time Session Information
9:00-9:20

Welcome and Preview

John Etchemendy, Denning Family Co-Director, Stanford Institute for Human-Centered Artificial Intelligence; Provost Emeritus, and Patrick Suppes Family Professor in the School of Humanities and Sciences, Stanford University

Fei-Fei Li, Denning Family Co-Director, Stanford Institute for Human-Centered Artificial Intelligence; Sequoia Professor of Computer Science, Stanford University
Russ Altman, Kenneth Fong Professor and Professor of Bioengineering, of Genetics, of Medicine (General Medical Discipline), of Biomedical Data Science, and, by courtesy, of Computer Science, Stanford University; Associate Director, Stanford Institute for Human-Centered Artificial Intelligence
Michele Elam, William Robertson Coe Professor of Humanities Department of English Center for Comparative Studies in Race & Ethnicity, Stanford University; Associate Director, Stanford Institute for Human-Centered Artificial Intelligence
Rob Reich, Professor of Political Science, Stanford University; Associate Director, Stanford Institute for Human-Centered Artificial Intelligence
9:20-10:30

Session I: Landscape and Framing

Talk Titles & Speakers

Challenges Responding to COVID-19: Perspectives from a Physician and Policy Maker
Congressman Ami Bera, California’s 7th Congressional District in the U.S. House of Representatives

  • past pandemics: SARS, MERS, EBOLA, ZIKA – preparedness during Obama, disband 12/2018, 11/2019 and 1/2020 reports from China on COVID-19 came along,U.S. House of Representatives
    • 2/2020 – Ban of Travel to China, preparedness was needed, UC, Davis at the front
    • CDC pushing own test cause lost of time – changing criteria social distancing
    • Sacramento County – Hospitals prepared and ramped up testing
    • FL and TX are lagging on ramped up testing and social distancing policy
    • Big data and AI in congress – as next steps
    • Korea, Singapore, China – Serological testing represent diffusion in the community and immunity in communities vs Diagnostics Testing (virus present or no)
    • John Hopkins Data Source – North hemisphere vs South hemisphere

An Academic Medical Center’s Data Science Response to a Pandemic
Nigam Shah, Associate Professor of Medicine (Biomedical Informatics) and of Biomedical Data Science, Stanford University

  • Operational Planning – Utilization – Resource planning
  • Clinical – who to test
  • Research Questions – ACE2 receptors
  • Epidemic simulations – when get out from lockdown
  • Next five Days – Predictions for 5 days using simulations: Growth rate & Disease burden
  • County like ONE huge hospital – rolled up to Regions
  • Relations from Social distancing and Hospital planning
  • Population studies: Geography information in Santa Clara county – Stanford Covid-19 Report
  • Administration to legally command Hotels and Companies to retool change temporary sovereignty

Issues in Responsible Reporting of COVID-19
Seema Yasmin, Director, Stanford Health Communication Initiative; Clinical Assistant Professor, Medicine, Primary Care and Population Health, Stanford University

  • Epidemic Intelligence Service Officer (Public Health Physician & Journalist on Pandemics and Epidemics
  • March 7, 2020 Italy news quarantine of 16 million lockdown large movement of people moving out of lockeddown areas, this movement based on information lead to spread of the viral spread
  • Hold information, report truth vs false
  • epidemic tool kit for Reporters

Global Best Practices in Controlling the COVID-19 Pandemic
Michele Barry, Professor, Senior Associate Dean, Global Health, Director, Center for Innovation in Global Health; Medicine & Senior Fellow, Woods Institute and at the Freeman Spogli Institute, Stanford University

  • 5Million people travel out of Huhan
  • Singapore – Free testing 1st country Temp testing stay at home, text phone from Authorities, show picture they are in quarantine for 5 days even if negative  – unified Government reporting, Daily messaging, chronicals, social responsibility
  • TRACE together – Bluetooth tool on distance among people  – Information on quarantine – no lockdown
  • CHINA – contact racing surveillance scanning temperature, strict social distancing
  • IRAN – religious interference at later date
  • Hong Kong – tracing bracelets for tracing quarantine Street locations of infected individuals no identity
  • USA – Lack of Testing, State responsibility, CDC nor allowed in a State if not invited
  • Evidence based intervention with AI
  • Masks instructions in the US different than the World: Paper mask vs cloth mask. Airborn infection will be mitigated by Masks of any materials not only paper – people can make to create OWN MADE masks
  • CHINA – Infection avoidance in Healthcare workers: Googles, Mask, Eye shields – lower infection of Health care workers

Panel Discussion and Audience Q&A
Moderator: Rob Reich

10:40-11:40

Session II: Social Impacts & Bio-Security

Talk Titles & Speakers

COVID-19 Infodemic and Crisis Informatics
Kate Starbird, Associate Professor, Human Centered Design & Engineering, University of Washington

  • Human responses to crisis anxiety and unknown
  • quarantine – collective sense making rumors
  • absence of information to make decisions
  • over abandance of information trustworthy vs misinformation vs disinformation
  • vulnerability to information searching seeking and sharing
  • crisis communicators: Trust in Official sources, use science for recommendations
  • Agencies risk loosing trust
  • Politician diminish trust by avoiding truth
  • Social Media took action to avoid misinformation vs disinformation going viral
  • Platforms take actions more at Present than in the Past due to lessons on misinformations
  • stifling and censoring are context dependent
  • misinformation vs disinformation Blames someone else like the US

COVID-19: Misinformation & Disinformation
Renée DiResta, Technical Research Manager, Stanford Internet Observatory

  • China’s English channels State sponsored narrative build Propaganda and control information
  • China White Information ecosystems channels – Attributable diplomats in the English language
  • Google bans China
  • China’s Informational Properties on Google
  • Significant audience on Google by China’s Informational Properties
  • China’s Informational Properties on Google Ads – need to manage perception of China related to narrative COVID-19 Pandemic January 2020, US is one month behind – representation of positive CHina due to response effectiveness vs the government of US positive handling of Infections in babies
  • Doctor discover was arrested was infected and DIED. China’s report was of a HERO doctor not mentioning his detention
  • Removal from SEO causes deemphasizing
  • CDC and WHO – recognitions of institutions as authorities

COVID-19 & Biosecurity
Megan Palmer, Senior Research Scholar, Stanford Center for International Security and Cooperation, Stanford University

  • evolving Security and Cooperation coordination defense
  • Pandemic consequences under estimated
  • Labs causing accidents
  • Avoiding over indexing an event
  • technology for Good vs Ill: AI and Vaccine vs devastating events by viruses
  • Novel viruses in Labs constructed by gene engineering in Switzerland lab posted on the Internet to develop vaccine – use can be negative – reconstruction of pathogens
  • Methods social psychology, gov.t strategy to new
  • AI used in Attribution
  • Infrastructure: Privacy, Sharing, security, surveillance
  • psychology of risk

“Foreign Bodies”: COVID-19 and Xenophobia
Eram Alam, Assistant Professor, History of Medicine, Harvard University

  • “Chinese Virus” Xenophobia
  • 1/27/2020 – 138 years apart 1882 – Chinese body perceived in Trade war between nations in adversarial relations related to security
  • body can be host victim by invading vectors
  • Social distance defined and redefined
  • Archival work and AI
  • Surveillance has material consequences, scientific good
  • Diet of Chinese including eating wild animals stigmatized – social distancing vs Europe and US Travel
  • foreignness of the viral becomes foreignness of the foreign body

Panel Discussion and Audience Q&A
Moderator: Rob Reich

  • Will the coronavirus pandemic change societies for the generations to come
11:50-1:30

Session III: Tracking the Epidemic

Talk Titles & Speakers

Taiwan’s Use of Data Analytics to Control COVID-19
Jason Wang, Director, Center for Policy, Outcomes and Prevention, Stanford University; Associate Professor of Pediatrics, The Lucile Salter Packard Children’s Hospital and of Medicine

  • Since 2003 Taiwan is preparing for a Pangemic, JAMA paper on the topic is beebn reported
  • Location of patient
  • Taiwan – National Epidemic Center 100 persons 24×7 in the Command Center
  • Taiwan activated the commend center in December 2019
  • All flight entering the country – Level 3 alert country: China Huhan, Hubei, another Chinese city
  • Quarantine all arriving from Level 3 alert country
  • National STOKE PILES Activated – production of masks from 2K to 11K per day
  • Logistics, articulate, agile,

Tools for Estimating Unreported Infections of COVID-19
Lucy Li, Infectious Data Scientist, Chan Zuckerberg Biohub

  • Undetected infection using viral genome sequencing
  • DIagnostics testing

Methods for Real Time Mapping of COVID-19 Cases Worldwide
John Brownstein, Professor, Department of Pediatrics, Harvard Medical School

  • Late December 2019 collecting dat a
  • HealthMap – public domain
  • Baidu – has movement information connected with cases
  • Temperature Data published
  • Buoy data base customized to collect MA data on Temperature
  • community mapping data for Health policies with epidemiological data

Epidemiological Forecasting Tools for COVID-19
Ryan Tibshirani, Associate Professor, Department of Statistics and Machine Learning Department, Carnegie Mellon University

  • CDC Forecasting Influenza – National and State level data captured is from Physicians – is one week old
  • Forecast next week
  • Hospitalization predicted
  • Worse case scenario
  • Mechanistic pf the disease differential equation
  • Statistical models are not available
  • DISTRIBUTION SHIFT – represent the prediction of a pandemic
  • Efforts from Influenza used for coronavirus
  • FOrecast distribution not cases or individuals

A Mobile App Intervention to Slow COVID-19 Using Crowdsourced Data
Tina White, Ph.D. Candidate, Department of Mechanical Engineering, Stanford University

  • China death toll >1000 China launched App to monitor quarantine early 1/2020
  • GPS based new App for contact tracing  – regulation on data from GPS 

AI for COVID-19: An Online Virtual Care Approach
Xavier Amatriain, CoFounder and CTO, Curai

  • Lack accessibility to health care systems
  • HC Accessibility and Scalability
  • AI based HC IT System
  • PDA – Personalized Diagnostics Assessment – for self reporting
  • AI Automations + Physicians + embed home testing _ Patients symptoms
  • BERT Language modelnavigate long questionnaire
  • ML + Expert system to create simulated cases to create a DIAGNOSTICS COVID-19 model

Knowledge Technology to Accelerate Open Science in Addressing the COVID-19 Pandemic
Mark Musen, Professor, Department of Medicine (Biomedical Informatics) and of Biomedical Data Science, Stanford University

  • Output of Science and of Data is shared for discoveries by all scientists
  • Data available without a catalogue – no Meta data Data interoperable, reusable,
  • Meta data: GEO at NIH find a specimen
  • NCBI BIOSample – data cleanup needed
  • FAIR Data on COVID-19 – CEDAR – Classes of experiments FORM/Template of data types at CEDAR at Stanford
  • VODAN – CEDAR Data infrastructure VODAN – Viral Ouput Data Network

What We Can Learn From Twitter Analysis About COVID-19
Johannes Eichstaedt, Assistant Professor (Research), Department of Psychology, Stanford University; HAI Junior Fellow

  • Unemployment and life satisfaction
  • Twitter analysis of Clusters of Tweets: Urban Areas: Buying panic
  • Educated counties
  • AGE –
  • Voting
  • Mental illness of loneliness – COVID-19 Adjustment

Panel Discussion and Audience Q&A
Moderator: Russ Altman

1:45- 3:00

Session IV: Treatments & Vaccines

Talk Titles & Speakers

Rapid Analysis of SARS-CoV-2 Genomic Content Using the Functional Genomics Platform
Kristen Beck, Lead Bioinformatician, AI and Cognitive Software, IBM

  • Functional Genomics Platform – in a RDB at IBM
  • COVID-19 Genes, proteins of +200 viruses for comparative analysis
  • Building AI by Training on Variants for anti-viral interactions SNAPS

COVID-19 Machine Learning Challenges
Anthony Goldbloom, Founder and CEO, Kaggle

Three channels @Kaggle

  • NLP Challenge – Coronavirus – all articles subjected to NLP key questions – Automated literature review
  • Forecast cases and fatalities by Cities and Counties by Latitute and Longitude: Different pattern among the entities
  • Data set curation models

Machine Learning Enabled Systems for Delivering Care to Critically Ill Patients 
Ron Li, Clinical Assistant Professor of Medicine, Hospital Medicine and Biomedical Informatics, Stanford University

  • AI used to deliver care to cCOVID19 patients
  • Interdependencies in care delivery using complex systems
  • Understanding the process: Managment Patients with COVID19 – Hospital to ICU intupation caused arosol that endanger Providers – workflow design and clinical data updates the model
  • ML Model validation and usefulness of the model RATE of CHANGE trigger intervention workflow

AI-Assisted Elderly Care for Acute Infection and Chronic Disease
Fei-Fei Li, Denning Family Co-Director, Stanford Institute for Human-Centered Artificial Intelligence; Sequoia Professor of Computer Science, Stanford University

  • AGE Fatality rate and infection rate of the aged
  • Interaction between Acute Infection and Chronic Disease
  • Safety of home – AI sensors at home
  • Sensors data on secure systems clinically data recognized from detection
  • Fever detection – Thermo sensor for detection
  • Mobility – infection behavior
  • Sleep – patterns
  • Diet – fluid intake and pill consumption
  • SMART SENSORS

Identifying COVID-19 Vaccine Candidates with ML
Binbin Chen, MD and Ph.D. Student, Department of Genetics, Stanford University

  • Immunogenic component of vaccine for COVID-19
  • spike protein bind epitome

Repurposing Existing Drugs to Fight COVID-19
Stefano Rensi, Research Engineer, Bioengineering Department, Stanford University

  • NLP – Mine the literature for Proteins: Genomes, genes, proteins
  • Biophysics – docking simulations for the energy of 18 molecules as inhibitors
  • Selection of candidate

Panel Discussion and Audience Q&A

Moderator: Russ Altman

3:00- 3:15

Wrap Up

 

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From @Harvardmed Center for Bioethics: The Medical Ethics of the Corona Virus Crisis

Reporter: Stephen J. Williams, Ph.D.

From Harvard Medical School Center for Bioethics

source: https://bioethics.hms.harvard.edu/news/medical-ethics-corona-virus-crisis

The Medical Ethics of the Corona Virus Crisis

Executive Director Christine Mitchell discusses the importance of institutions talking through the implications of their decisions with the New Yorker.

Center Executive Director Christine Mitchell spoke with the New Yorker’s Isaac Chotiner about the decisions that may need to be made on limiting movement and, potentially, rationing supplies and hospital space.

“So, in the debate about allocating resources in a pandemic, we have to work with our colleagues around what kind of space is going to be made available—which means that other people and other services have to be dislocated—what kind of supplies we’re going to have, whether we’re going to reuse them, how we will reallocate staff, whether we can have staff who are not specialists take care of patients because we have way more patients than the number of specialized staff,” says Mitchell.

Read the full Q&A in the New Yorker.

 

Note: The following is taken from the Interview in the New Yorker.

As the novel coronaviruscovid-19, spreads across the globe, governments have been taking increasingly severe measures to limit the virus’s infection rate. China, where it originated, has instituted quarantines in areas with a large number of cases, and Italy—which is now facing perhaps the most serious threat outside of China—is entirely under quarantine. In the United States, the National Guard has been deployed to manage a “containment area” in New Rochelle, New York, where one of the country’s largest clusters has emerged. As the number of cases rises, we will soon face decisions on limiting movement and, potentially, rationing supplies and hospital space. These issues will be decided at the highest level by politicians, but they are often influenced by medical ethicists, who advise governments and other institutions about the way to handle medical emergencies.

One of those ethicists, with whom I recently spoke by phone, is Christine Mitchell, the executive director at the Center for Bioethics at Harvard Medical School. Mitchell, who has master’s degrees in nursing and philosophical and religious ethics, has been a clinical ethicist for thirty years. She founded the ethics program at Boston Children’s Hospital, and has served on national and international medical-ethics commissions. During our conversation, which has been edited for length and clarity, we discussed what ethicists tend to focus on during a health crisis, how existing health-care access affects crisis response, and the importance of institutions talking through the ethical implications of their decisions.

What coronavirus-related issue has most occupied your mental space over the past weeks?

One of the things I think about but that we don’t often have an opportunity to talk about, when we are mostly focussing on what clinicians are doing and trying to prepare for, is the more general ways this affects our society. People get sick out there in the real world, and then they come to our hospitals, but, when they are sick, a whole bunch of them don’t have health insurance, or are afraid to come to a hospital, or they don’t have coverage for sick time or taking a day off when their child is sick, so they send their child to school. So these all have very significant influences on our ability to manage population health and community transmission that aren’t things that nurses and physicians and people who work in acute-care hospitals and clinics can really affect. They are elements of the way our society is structured and has failed to meet the needs of our general population, and they influence our ability to manage a crisis like this.

Is there anything specifically about a pandemic or something like coronavirus that makes these issues especially acute?

If a person doesn’t have health insurance and doesn’t come to be tested or treated, and if they don’t have sick-time coverage and can’t leave work, so they teach at a school, or they work at a restaurant, or do events that have large numbers of people, these are all ways in which the spread of a virus like this has to be managed—and yet can’t be managed effectively because of our social-welfare policies, not just our health-care resources.

Just to take a step back, and I want to get back to coronavirus stuff, but what got you interested in medical ethics?

What got me interested were the actual kinds of problems that came up when I was taking care of patients, starting as early as when I was in nursing school and was taking care of a patient who, as a teen-ager, had a terminal kind of cancer that his parents didn’t want him to know about, and which the health-care team had decided to defer to the parents. And yet I was spending every day taking care of him, and he was really puzzled about why he was so sick and whether he was going to get better, and so forth. And so of course I was faced with this question of, What do I do if he asks me? Which, of course, he did.

And this question about what you should tell an adolescent and whether the deference should be to his parents’ judgment about what’s best for him, which we would ordinarily respect, and the moral demands of the relationship that you have with a patient, was one of the cases that reminded me that there’s a lot more to being a nurse or a health-care provider than just knowing how to give cancer chemotherapy and change a bed, or change a dressing, or whatever. That a lot of it is in the relationship you have with a patient and the kinds of ethical choices they and their families are facing. They need your information, but also your help as they think things through. That’s the kind of thing that got me interested in it. There are a whole host of those kinds of cases, but they’re more individual cases.

As I began to work in a hospital as an ethicist, I began to worry about the broader organizational issues, like emergency preparedness. Some years ago, here in Boston, I had a joint appointment running the ethics program at Children’s Hospital and doing clinical ethics at Harvard Medical School. We pulled together a group, with the Department of Public Health and the emergency-preparedness clinicians in the Harvard-affiliated hospitals, to look at what the response within the state of Massachusetts should be to big, major disasters or rolling pandemics, and worked on some guidelines together.

When you looked at the response of our government, in a place like Washington State or in New York City, what things, from a medical-ethics perspective, are you noticing that are either good or maybe not so good?

To be candid and, probably, to use language that’s too sharp for publication, I’m appalled. We didn’t get ourselves ready. We’ve had outbreaks—sars in 2003, H1N1 in 2009, Ebola in 2013, Zika in 2016. We’ve known, and the general population in some ways has known. They even have movies like “Contagion” that did a great job of sharing publicly what this is like, although it is fictional, and that we were going to have these kinds of infectious diseases in a global community that we have to be prepared to handle. And we didn’t get ourselves as ready, in most cases, as we should have. There have been all these cuts to the C.D.C. budget, and the person who was the Ebola czar no longer exists in the new Administration.

And it’s not just this Administration. But the thing about this Administration that perhaps worries me the most is a fundamental lack of respect for science and the facts. Managing the crisis from a public-relations perspective and an economic, Dow Jones perspective are important, but they shouldn’t be fudging the facts. And that’s the piece that makes me feel most concerned—and not just as an ethicist. And then, of course, I want to see public education and information that’s forthright and helps people get the treatment that they need. But the disrespect for the public, and not providing honest information, is . . . yeah, that’s pretty disconcerting.

SOURCE

https://www.newyorker.com/news/q-and-a/the-medical-ethics-of-the-coronavirus-crisis

See more on this and #COVID19 on this Online Open Access Journal at our Coronavirus Portal at

https://pharmaceuticalintelligence.com/coronavirus-portal/

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